[1]卓红平,王毅,周德伟,等.显微镜下多血管炎咯血前胸部CT表现与临床意义[J].第三军医大学学报,2016,38(12):1457-1461.
 Zhuo Hongping,Wang Yi,Zhou Dewei,et al.Manifestations and clinical significance of chest CT images in microscopic polyangiitis patients before pulmonary hemoptysis[J].J Third Mil Med Univ,2016,38(12):1457-1461.
点击复制

显微镜下多血管炎咯血前胸部CT表现与临床意义(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
38卷
期数:
2016年第12期
页码:
1457-1461
栏目:
临床医学
出版日期:
2016-06-30

文章信息/Info

Title:
Manifestations and clinical significance of chest CT images in microscopic polyangiitis patients before pulmonary hemoptysis
作者:
卓红平王毅周德伟曾明彬
资阳市第一人民医院医学影像科;第三军医大学大坪医院野战外科研究所放射科
Author(s):
Zhuo Hongping Wang Yi Zhou DeweiZeng Mingbin

Department of Medical Imaging, First People’s Hospital of Ziyang City, Ziyang, Sichuan Province, 641300; Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China

关键词:
显微镜下多血管炎咯血胸部CT
Keywords:
microscopic polyangiitis pulmonary hemoptysis pulmonary CT
分类号:
R441.7; R593.2; R814.42
文献标志码:
A
摘要:

目的      探讨显微镜下多血管炎患者(microscopic polyangiitis,MPA)咯血前的胸部CT影像学特点及其临床意义。      方法      回顾性分析30例确诊为MPA的胸部CT影像学表现和临床资料,其中咯血组11例,非咯血组19例,分析咯血组在咯血前的胸部CT影像学特点、临床资料,并与非咯血组对比。      结果      30例患者均有不同程度的胸部CT异常表现,其中斑片影13例(43.3%),实变影8例(26.7%),磨玻璃影13例(43.3%);网格影14例(46.7%),胸腔积液20例(66.7%),肺大泡15例(50.0%),纵隔淋巴结肿大11例(36.7%),支气管扩张9例(30.0%),空洞1例(3.3%)为咯血组患者,小叶间隔增厚7例(23.3%)和结节影2例(6.7%)均为非咯血组患者,纤维条索影25例(83.3%)。咯血组较非咯血组的斑片影、实变影、磨玻璃影、网格影明显增加(P<0.05),咯血组患者在初次胸部CT影像学异常表现2~14 d后均出现不同程度的咯血。咯血组患者胸痛、咳嗽咯痰、心累气紧和炎症指标与非咯血组差异有统计学意义(P<0.05)。      结论      MPA患者肺部广泛的斑片影、实变影、磨玻璃影、网格影CT表现结合胸痛、咳嗽咯痰、心累气紧和炎症指标升高提示可能出现肺咯血。

Abstract:

Objective      To explore the manifestations and clinical significance of chest CT images in microscopic polyangiitis (MPA) patients before pulmonary hemoptysis.       Methods      Clinical data and chest CT images of 30 patients diagnosed with MPA in First People’s Hospital of Ziyang City from January 2013 to September 2015 were analyzed retrospectively. Depending on clinical manifestations, the 30 cases of MPA were divided into 11 cases of pulmonary hemoptysis group and 19 cases of non-pulmonary hemoptysis group. The characteristics of CT images and clinical data of patients with hemoptysis before pulmonary hemoptysis were analyzed and compared with those of the patients without hemoptysis.       Results      All CT images were abnormal in 30 cases of MPA, including 13 cases of patchy opacities (43.3%), 8 cases of lung consolidations (26.7%), 13 cases of ground glass opacities (43.3%), 14 cases of reticular opacities (46.7%), 20 cases of pleural effusions (66.7%), 15 cases of emphysema (50%), 11 cases of mediastinal adenopathies (36.7%), 9 cases of bronchial dilatation (30%), 1 case of empty opacities (3.3%), 7 cases of leaflet septal thickening opacities (23.3%), 2 cases of nodular opacities (6.7%), and 25 cases of fiber stripe opacities (83.3%). Patchy opacities, lung consolidations, ground glass opacities, and reticular opacities were more common in the pulmonary hemoptysis group than in the non-pulmonary hemoptysis group (P<0.05). The patients in the hemoptysis group had hemoptysis at different degrees in 2 to 14 d after the abnormal CT images were observed. Chest pain, cough, expectoration, short breath and inflammation index were more common in the pulmonary hemoptysis group than in the non-pulmonary hemoptysis group (P<0.05).       Conclusion      The hemoptysis may happen in the MPA patients with chest pain, cough, expectoration, short breath and elevated inflammation index when the CT images show patchy opacities, lung consolidations, ground glass opacities and reticular opacities.
 

参考文献/References:

[1]唐莎, 张静波. ANCA相关性血管炎的免疫发病机制新进展[J]. 免疫学杂志, 2013, 29(7): 628-631. DOI:10.13431/j.cnki.immunol.j.20130135
[2]Lally L, Spiera R. Current landscape of antineutrophil cytoplasmic antibody-associated vasculitis: classification, diagnosis, and treatment[J]. Rheum Dis Clin North Am, 2015, 41(1): 1-19,vii. DOI:10.1016/j.rdc.2014.09.003
[3]Kallenberg C G. Key advances in the clinical approach to ANCA-associated vasculitis[J]. Nat Rev Rheumatol, 2014, 10(8): 484-493. DOI:10.1038/nrrheum.2014.104
[4]Zhou X J, Cheng F J, Lv J C, et al. Higher DEFB4 genomic copy number in SLE and ANCA-associated small vasculitis[J]. Rheumatology (Oxford), 2012, 51(6): 992- 995. DOI:10.1093/rheumatology/ker419
[5]Gatenby P A. Anti-neutrophil cytoplasmic antibody-associated systemic vasculitis: nature or nurture?[J]. Intern Med J, 2012, 42(4): 351-359. DOI: 10.1111/j.1445-5994.2011.02705.x
[6]Csernok E, Lamprecht P, Gross W L. Clinical and immunological features of drug-induced and infection-induced proteinase 3-antineutrophil cytoplasmic antibodies and myeloperoxidase-antineutrophil cytoplasmic antibodies and vasculitis[J]. Curr Opin Rheumatol, 2010, 22(1): 43-48. DOI: 10.1097/BOR. 0b013e3283323538
[7]Laudien M, Gadola S D, Podschun R, et al. Nasal carriage of Staphylococcus aureus and endonasal activity in Wegener's granulomatosis as compared to rheumatoid arthritis and chronic Rhinosinusitis with nasal polyps[J]. Clin Exp Rheumatol, 2010, 28(1 Sippl 57): 51-55.
[8]陈旻. KDIGO指南解读:血管炎肾损伤治疗[J].中国实用内科杂志, 2012, 32(12): 932-934.
[9]Collins C E, Quismorio F P Jr. Pulmonary involvement in microscopic polyangiitis [J]. Curr Opin Pulm Med, 2005, 11(5): 447-451.DOI:10.1097/01.mcp.0000170520.63874.fb
[10]Mueller A, Holl-Ulrich K, Lamprecht P, et al. Germinal centre-like structures in Wegener’s granuloma: the morphological basis for autoimmunity?[J]. Rheumatology (Oxford), 2008, 47(8): 1111-1113. DOI: 10.1093/rheumatology/ken202
[11]Eschun G M, Mink S N, Sharma S. Pulmonary interstitial fibrosis as a presenting manifestation in perinuclear antineutrophilic cytoplasmic antibody microscopic polyangiitis[J]. Chest, 2003, 123(1): 297-301. DOI: 10.1378/chest.123.1.297
[12]Tzelepis G E, Kokosi M, Tzioufas A, et al. Prevalence and outcome of pulmonary fibrosis in microscopic polyangiitis[J]. Eur Respir J, 2010, 36 (1): 116-121. DOI: 10.1183/09031936.00110109
[13]Arulkumaran N, Periselneris N, Gaskin G, et al. Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study [J]. Rheumatology (Oxford), 2011, 50(11): 2035-2043. DOI: 10.1093/rheumatology/ker236
[14]Homma S, Matsushita H, Nakata K. Pulmonary fibrosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitides[J]. Respirology, 2004, 9(2): 190-196. DOI: 10.1111/j.1440-1843.2004.00581.x
[15]Yamada H. ANCA: associated lung fibrosis[J]. Semin Respir Crit Care Med, 2011, 32(3): 322-327. DOI: 10.1055/s-0031-1279828
[16]Birnbaum J, Danoff S, Askin F B, et al. Microscopic polyangiitis presenting as a “pulmonary-muscle” syndrome: is subclinical alveolar hemorrhage the mechanism of pulmonary fibrosis?[J]. Arthritis Rheum, 2007, 56(6): 2065-2071. DOI: 10.1002/art.22633
[17]Pankhurst T, Savage C O. Pathogenic role of anti-neutrophil cytoplasmic antibodies in vasculitis[J]. Curr Opin Pharmacol, 2006, 6(2): 190-196. DOI: 10.1016/j.coph.2005.10.009

相似文献/References:

[1]李琦,吴景全,罗天友,等.64层螺旋CT血管成像在咯血诊疗中的临床价值[J].第三军医大学学报,2008,30(22):2132.
 LI Qi,WU Jing-quan,LUO Tian-you,et al.Clinical value of 64-slice spiral CT angiography in the diagnosis and treatment of hemoptysis[J].J Third Mil Med Univ,2008,30(12):2132.
[2]郭艳红,程悦,陈枫,等.肺出血-肾炎综合征1例[J].第三军医大学学报,2007,29(05):379.
[3]杨松,张耀亭.酚妥拉明与垂体后叶素治疗重症肺结核咯血的比较研究[J].第三军医大学学报,2004,26(20):0.[doi:10.16016/j.1000-5404.2004.20.037 ]
[4]吴贵华,牟玮,刘凤秀,等.肺癌并大咯血、高热的介入治疗[J].第三军医大学学报,1992,14(05):0.[doi:10.16016/j.1000-5404.1992.05.037 ]

更新日期/Last Update: 2016-06-08